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Tayh G, Fhoula I, Said MB, Boudabous A, Slama KB. Prevalence and characterization of quinolone resistance and integrons in clinical Gram-negative isolates from Gaza strip, Palestine. Mol Biol Rep 2024; 51:855. [PMID: 39066817 DOI: 10.1007/s11033-024-09721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Gram-negative bacteria with quinolone resistance and extended-spectrum beta-lactamases (ESBLs) present significant treatment challenges. This study evaluated the prevalence and characteristics of quinolone resistance in Gram-negative strains, investigating the relationship between plasmid-mediated quinolone resistance (PMQR), ESBLs, and integrons. METHODS AND RESULTS We collected 146 Gram-negative isolates from patients in three Palestinian hospitals. For quinolone resistance isolates, the presence and characterization of PMQR, β-lactamase genes and integrons were studied by PCR and sequencing. Out of 146 clinical isolates, 64 (43.8%) were resistant to quinolones, with 62 (97%) being multidrug-resistant (MDR) and 33 (51.5%) ESBL-producers. PMQR-encoding genes were present in 45 (70.3%) isolates, including aac(6')-Ib-cr (26.6%), qnrA (18.8%), qnrS1 (20.8%), and qnrB (6.4%). BlaCTX-M genes were detected in 50% (32/64) of isolates, with blaCTX-M-15 being the most common. BlaTEM-1, blaSHV-1 and blaVIM genes were found in 13, 6, and 4 isolates, respectively. Class I integrons were found in 31/64 (48%) of isolates, with 14 containing gene cassettes conferring resistance to trimethoprim (dhfr17, dfrA12, dfrA1) and aminoglycosides resistance genes (aadA1, aadA2, aadA5, and aadA6). CONCLUSIONS This study found a high rate of quinolone resistance, ESBL and integrons in clinical Gram-negative isolates from our hospitals. Urgent measures are crucial, including implementing an antimicrobial resistance surveillance system, to control and continuously monitor the development of antimicrobial resistance.
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Affiliation(s)
- Ghassan Tayh
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, LR03ES03, Tunis, Tunis 2092, Tunisia.
- Department of Microbiology and Immunology, National School of Veterinary Medicine, University of Manouba, LR16AGR01, Sidi Thabet 2020, Ariana, Tunisia.
| | - Imene Fhoula
- Laboratory of Microbiology-Biochemistry, Aziza Othmana Hospital, University of Tunis, Tunis, 1008, Tunisia
| | - Mourad Ben Said
- Department of Microbiology and Immunology, National School of Veterinary Medicine, University of Manouba, LR16AGR01, Sidi Thabet 2020, Ariana, Tunisia
- Department of Basic Sciences, Higher Institute of Biotechnology of Sidi Thabet, University of Manouba, Manouba, Tunisia
| | - Abdellatif Boudabous
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, LR03ES03, Tunis, Tunis 2092, Tunisia
| | - Karim Ben Slama
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, LR03ES03, Tunis, Tunis 2092, Tunisia
- Higher Institute of Applied Biological Sciences of Tunis - University of Tunis El Manar, Tunis, 1006, Tunisia
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Study of Plasmid-Mediated Quinolone Resistance in Klebsiella pneumoniae: Relation to Extended-Spectrum Beta-Lactamases. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Klebsiella pneumoniae (K. pneumoniae) is an important pathogen associated with various infections. The emergence of antibiotic resistances, such as quinolone resistance and those due to extended-spectrum beta-lactamases (ESBL), reduces the available choices for treatment. The objectives of the current study include the evaluation of the prevalence of the plasmid-mediated quinolone resistance genes qepA, acrA, acrB, and aac(6’)-Ib-cr by polymerase chain reaction (PCR) in K. pneumoniae and the determination of the mechanism relating these genes to the ESBL phenotype and resistance to other groups of antibiotics. In total, 300 clinical isolates of K. pneumoniae were included in the study. Isolates were subjected to antibiotic sensitivity tests using the disc diffusion method. Quinolone resistance by the minimum inhibitory concentration method and detection of ESBL resistance by the double disc diffusion method were also determined. PCR analyses revealed the prevalence of acrA, aac(6’)-Ib-cr, acrB, and qepA in 74.3%, 73.7%, 71%, and 6.7% of the isolates, respectively. Quinolone-resistant isolates positive for plasmid-encoded genes represented 82.7% of K. pneumoniae isolates positive for ESBL activity. The results also showed that the isolates of K. pneumoniae carrying plasmid-encoded quinolone resistance genes had significantly increased resistance to amikacin, amoxicillin/clavulanate, gentamicin, and cefoxitin than those isolates without quinolone resistance genes. Therefore, there was a high prevalence of acrA, acrB, and aac(6’)-Ib-cr among K. pneumoniae and the prevalence of quinolone resistance was significantly associated with the ESBL resistance phenotype. Moreover, the presence of quinolone resistance genes was associated with resistance to aminoglycosides, namely amikacin and gentamicin.
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Jomehzadeh N, Saki M, Ahmadi K, Zandi G. The prevalence of plasmid-mediated quinolone resistance genes among Escherichia coli strains isolated from urinary tract infections in southwest Iran. Mol Biol Rep 2022; 49:3757-3763. [PMID: 35301647 DOI: 10.1007/s11033-022-07215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The extensive and inappropriate use of quinolones, which are frequently used as an effective treatment for urinary tract infection (UTI) patients, has led to resistance to these antibiotics. This study was designed to determine the prevalence of quinolones resistance and the presence of plasmid-mediated quinolone resistance (PMQR) genes among extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates. METHODS One hundred and fourteen E. coli isolates were collected from patients' urine samples. The susceptibility of isolates to selected antibiotics was tested by the Kirby-Bauer disk diffusion method. ESBL-producing isolates were identified phenotypically using a combination disk test. Using specific primers, the frequency of aac (6')-Ib, qnrA, qnrB, qnrC, qnrD, qnrS, and qepA genes was investigated by polymerase chain reaction (PCR). RESULTS Among 26 ESBL-producing isolates, the highest resistance rate was observed toward nalidixic acid (80.8%) and ciprofloxacin (61.5%), respectively. Ninety-seven (85%) of all isolates harbored at least one PMQR gene, the most frequent one being aac(6')-Ib-cr variant (47.4%). Coexistence of aac(6')-Ib-cr variant and qnrB were the most broadly distributed genotype among quinolone resistance isolates. Notably, none of the isolates contained the qnrC, qnrD, and qepA genes. CONCLUSIONS Our results highlight the significant prevalence of PMQR genes in ESBL-producing E. coli isolates in this region. Also, the aac (6')-Ib-cr variant was the most frequent gene, particularly in ESBL positive isolates. A regular periodic monitoring program is needed to control and hinder the more spread of antibiotic resistance phenomenon and contributed genes among UTI-causing E. coli isolates.
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Affiliation(s)
- Nabi Jomehzadeh
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran.
| | - Morteza Saki
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Khadijeh Ahmadi
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - Golshan Zandi
- Department of Microbiology, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran
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Lord J, Gikonyo A, Miwa A, Odoi A. Antimicrobial resistance among Enterobacteriaceae, Staphylococcus aureus, and Pseudomonas spp. isolates from clinical specimens from a hospital in Nairobi, Kenya. PeerJ 2021; 9:e11958. [PMID: 34557345 PMCID: PMC8418212 DOI: 10.7717/peerj.11958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Antimicrobial resistance among pathogens of public health importance is an emerging problem in sub-Saharan Africa. Unfortunately, published information on the burden and patterns of antimicrobial resistance (AMR) in this region is sparse. There is evidence that the burden and patterns of AMR vary by geography and facility. Knowledge of local epidemiology of AMR is thus important for guiding clinical decisions and mitigation strategies. Therefore, the objective of this study was to determine the burden and predictors of AMR and multidrug resistance (MDR) among bacterial pathogens isolated from specimens submitted to the diagnostic laboratory of a hospital in Nairobi, Kenya. Methods This retrospective study used laboratory records of 1,217 clinical specimens submitted for bacterial culture and sensitivity testing at the diagnostic laboratory of The Karen Hospital in Nairobi, Kenya between 2012 and 2016. Records from specimens positive for Enterobacteriaceae, Staphylococcus aureus, or Pseudomonas spp. isolates were included for analysis. Firth logistic models, which minimize small sample bias, were used to investigate determinants of AMR and MDR of the isolates. Results A total of 222 specimens had bacterial growth. Most Enterobacteriaceae isolates were resistant to commonly used drugs such as penicillin/β-lactamase inhibitor combinations (91.2%) and folate pathway inhibitors (83.7%). Resistance to extended-spectrum cephalosporins was also high (52.9%). Levels of AMR and MDR for Enterobacteriaceae were 88.5% and 51%, respectively. Among S. aureus isolates, 57.1% were AMR, while 16.7% were MDR. As many as 42.1% of the Pseudomonas spp. isolates were aminoglycoside-resistant and 15% were fluoroquinolone-resistant, but none exhibited resistance to antipseudomonal carbapenems. Half of Pseudomonas spp. isolates were AMR but none were MDR. Significant predictors of MDR among Enterobacteriaceae were organism species (p = 0.002) and patient gender (p = 0.024). Conclusions The high levels of extended-spectrum cephalosporin resistance and MDR among Enterobacteriaceae isolates are concerning. However, the relatively low levels of MDR S. aureus, and an absence of carbapenem resistance among Pseudomonas isolates, suggests that last-line drugs are still effective against S. aureus and Pseudomonas infections. These findings are relevant for guiding evidence-based treatment decisions as well as surveillance efforts and directions for future research, and contribute to the sparse literature on AMR in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Lord
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | | | | | - Agricola Odoi
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
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Ghanavati R, Kazemian H, Asadollahi P, Heidari H, Irajian G, Navab-Moghadam F, Razavi S. Characterization of Antimicrobial Resistance Patterns of Klebsiella pneumoniae Isolates Obtained from Wound Infections. Infect Disord Drug Targets 2021; 21:119-124. [PMID: 31995023 DOI: 10.2174/1871526520666200129124924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 01/04/2023]
Abstract
CDATA[Background: Multidrug resistance among ESBL producing isolates has limited the administration of proper antibiotics. It is, therefore, important to monitor the resistance patterns of Klebsiella pneumoniae isolates and provide infection control strategies to prevent nosocomial outbreaks. This study was aimed to determine antimicrobial resistance patterns of K. pneumoniae isolates obtained from wound infections of patients in Tehran, Iran. METHODS A total of 102 K. pneumoniae isolates were obtained from wound infections of patients in Tehran, Iran. The production of phenotypic ESBL and carbapenemase was assessed using the double-disc synergy test (DDST) and modified Hodge test (MHT), respectively. PCR was performed for the detection of ESBL, carbapenemase, quinolone and aminoglycoside resistance genes. RESULTS Forty-six (45.1%) and 23 (22.5%) isolates, out of the 102 isolates, were phenotypically detected as ESBL and carbapenemase producers, respectively. The PCR results showed that 80/102 (78.4%) and 51/102 (50%) isolates possessed at least one of the assessed ESBL and carbapenemase genes, respectively. Quinolone resistance determinants (QRDs) and aac(6')-Ib genes were found amongst 50 (49%) and 67 (65.7%) isolates, respectively. Four isolates carried blaTEM, blaSHV, blaCTX-M, qnrB, qnrS and aac(6')-Ib genes, simultaneously. CONCLUSION Due to the presence of multiple resistance genes among some K. pneumoniae strains, antibiotic agents should be used with caution to preserve their efficacy in case of life-threatening infections.
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Affiliation(s)
- Roya Ghanavati
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Kazemian
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Parisa Asadollahi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Heidari
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Gholamreza Irajian
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Navab-Moghadam
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Razavi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Benaissa E, Elmrimar N, Belouad E, Mechal Y, Ghazouani M, Bsaibiss F, Benlahlou Y, Chadli M, Touil N, Lemnaouer A, Maleb A, Elouennass M. Update on the resistance of Escherichia coli isolated from urine specimens in a Moroccan hospital: a review of a 7-year period. Germs 2021; 11:189-198. [PMID: 34422691 DOI: 10.18683/germs.2021.1256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/08/2022]
Abstract
Introduction Escherichia coli is the most commonly isolated species in both community and healthcare-associated infections. Our study's purpose was to determine the rates of antibiotic resistance of E. coli isolates in hospital and community populations, track the kinetics of resistance rates of E. coli isolates to major antibiotics, particularly those prescribed for urinary tract infections and study the occurrence and evolution of multi-resistant phenotypes. Methods We conducted a retrospective study at the Bacteriological Department of the Mohammed V Military Hospital of Instruction, over a period of 7 years. All isolates of E. coli from inpatients and outpatients were included. Identification of bacterial isolates was based on culture, morphological and biochemical identification characteristics. Antibiotic susceptibility was studied using the Mueller Hilton agar diffusion method by using OXOID® type antibiotic discs and interpreted according to the recommendations of EUCAST/CA-SFM 2019. Results The rate of resistance of E. coli isolates to 3rd generation cephalosporins, imipenem and fluoroquinolones was 12%, 1% and 34%, respectively. The difference between the resistance rates of inpatient and outpatient E. coli isolates was statistically significant for most antibiotics (p<0.05). The rate of extended-spectrum beta-lactamase phenotype (ESBL) was 6.73%. The carbapenemase phenotype was 1.25%. The ESBL phenotype rate increased from 3% in 2012 to 11.16% in 2018. Conclusions The progression of the ESBL phenotype in both hospital and community settings, due to the increase in the resistance rate to 3rd generation cephalosporin, is prompting a review of the strategy for the therapeutic management of urinary tract infections with these molecules as probabilistic treatment.
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Affiliation(s)
- Elmostafa Benaissa
- PhD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Nadia Elmrimar
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Elmehdi Belouad
- MSc, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Youness Mechal
- PhD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mohammed Ghazouani
- MSc, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Fatna Bsaibiss
- MSc, Department of Clinical Bacteriology, Mohammed V Military Teaching. Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Yassine Benlahlou
- PhD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mariama Chadli
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Nadia Touil
- PhD, Research and Biosafety Laboratory, Mohammed V Military Teaching Hospital / Faculty of Medicine and Pharmacy, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Abdelhay Lemnaouer
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Adil Maleb
- PhD, Department of Clinical Bacteriology, Mohammed VI Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mostafa Elouennass
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
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Arhoune B, El Fakir S, Himri S, Moutaouakkil K, El Hassouni S, Benboubker M, Hmami F, Oumokhtar B. Intense intestinal carriage and subsequent acquisition of multidrug-resistant enterobacteria in neonatal intensive care unit in Morocco. PLoS One 2021; 16:e0251810. [PMID: 34191805 PMCID: PMC8244853 DOI: 10.1371/journal.pone.0251810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
This study was conducted in order to know the colonization rate of MDR enterobacteria in neonates during their hospitalization in neonatal intensive care unit (NICU). Furthermore, we investigated risk factors for potential colonization and molecular epidemiology of isolated resistant bacteria. This prospective study was carried out in the neonatology and intensive care unit department of the University Hospital of Fez (Morocco) from February 2013 to July 2015. All consecutive admitted newborns were screened for intestinal and nasal carriage of MDR enterobacteria at admission of the babies and during the hospitalization. During the study period, a total of 641 Enterobacteriaceae were isolated and Klebsiella pneumoniae was the predominated bacteria. Bacterial identification and antibiograms were performed according to the international standards. On admission, 455 newborns were screened. A median age of these newborns was 1 day with an extended 147 days and their average weight was 2612 ± 1023 grams. 22.4% of neonates were found colonized by an ESBL producing Enterobacteriaceae (ESBL-E), 8.7% by a carbapenemases producing Enterobacteriaceae (CPE). During hospitalization, 207 of newborns were included in the acquisition study. 59.4% of newborns acquired an ESBL-E during their stay, 12.5% has acquired CPE. The blaCTXM-15 gene was the most frequently detected (81.2%) among ESBL-E. While, all CPE has expressed the blaOXA-48 gene exclusively. Two risk factors have been significantly associated with MDR enterobacteria colonization at admission which are newborns admission from maternity of the university hospital (95% CI, 1.859-5.129, P = 0.000) and neurological distress (95% CI, 1.038 to 4.694, P = 0.040). During hospitalization, the none risk factor was significantly associated with the carriage of MDR-E. The high rate of colonization, the MDR enterobacteria and the resistance genes found represent good indicator of cross-transmission in the NICU. An active strategy to control the spread of MDR enterobacteria should be applied.
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Affiliation(s)
- Btissam Arhoune
- Laboratory of Microbiology and Molecular biology, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Samira El Fakir
- Laboratory of Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Sara Himri
- Laboratory of Microbiology and Molecular biology, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Kaoutar Moutaouakkil
- Laboratory of Microbiology and Molecular biology, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Salma El Hassouni
- Laboratory of Microbiology and Molecular biology, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Moussa Benboubker
- Laboratory of Microbiology and Molecular biology, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Fouzia Hmami
- Neonatal Intensive Care Unit, University Hospital Hassan II, Fez, Morocco
| | - Bouchra Oumokhtar
- Laboratory of Microbiology and Molecular biology, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
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Zaki MES, El Salam MA, Faried OA. Study of Plasmid-Mediated Quinolone Resistance in Escherichia coli from Nosocomial Urinary Tract Infections. Infect Disord Drug Targets 2021; 21:243-247. [PMID: 32433009 DOI: 10.2174/1871526520666200520112319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/24/2019] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
The aim of the present study was to study the prevalence of plasmid-mediated quinolone resistance (PMQR) genes (qnrA, qnrB, qnrC, qnrD, qnrS, qepA, oqxA, oqxB and aac) in Escherichia coli (E. coli) isolated from patients with nosocomial urinary tract infections (UTIs) and its relation to the extended-spectrum β-lactamase (ESBL) production. ; Methods: A cross-sectional study was carried out on 200 non-duplicated isolates of E. coli isolated from patients with nosocomial UTIs. E.coli isolates were subjected to antibiotic susceptibility testing by disc diffusion method, determination of minimum inhibitory concentrations (MICs) of ciprofloxacin by Epsillometer (E) test strips, detection of ESBL production by double disc synergy method and detection of qnrA, qnrB, qnrC, qnrD, qnrS, qepA, oqxA, oqxB and aac genes by polymerase chain reaction (PCR). ; Results: The antimicrobial susceptibility testing of the isolated E. coli revealed a high frequency of resistance to ampicillin (73.5%), ceftazidime (72%) and imipenem (71.5%). The less frequent resistance was for aztreonam (21.5%), amikacin (36.5%) and gentamicin (38.5%). ESBL production was found in 131 isolates (65.5%) and phenotypic quinolone resistance was detected by MIC in 65 isolates (32.5%), with 52.3% of them showed high resistance to ciprofloxacin with an MIC more than 32 μg/ml. PMQR genes were found in 40 isolates. The frequency of the detected genes was 40%, 37.5%, 35%, 20% and 5% for qnrA, qnrS, qepA, qnrB and oqxA, respectively. Significant association was found between the presence of PMQR genes and ESBL production (P=0.0001). ; Conclusion: The study highlights the prevalence of PMQR genes in E. coli with high association with the ESBL phenotype. This finding is a sign of limited therapeutic options for E. coli.
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Affiliation(s)
| | - Mostafa Abd El Salam
- Nephrology Unit, Internal Medicine Department, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Osama Ahmed Faried
- Medical Microbiology and Immunology Department, Faculty of Medicine, Beni-suef University, Egypt
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El-Domany RA, Awadalla OA, Shabana SA, El-Dardir MA, Emara M. Analysis of the Correlation Between Antibiotic Resistance Patterns and Virulence Determinants in Pathogenic Klebsiella pneumoniae Isolates from Egypt. Microb Drug Resist 2020; 27:727-739. [PMID: 33103956 DOI: 10.1089/mdr.2020.0236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Klebsiella pneumoniae is responsible for a plethora of infections involving multiple body systems. This study investigated K. pneumoniae clinical isolates for virulence-associated characters and antibiotic resistance. First, antibiotic sensitivity was determined for 40 K. pneumoniae clinical isolates. Some virulence and resistance-associated factors were studied phenotypically and genotypically. Multiple resistance profiles were observed (multidrug resistant [MDR; 42.5%], extensive drug resistant [XDR; 35%], and pandrug resistant [PDR; 5%]). Moreover, CTX-M-1, TEM, qnrS, and qnrA genes were detected in 70%, 30%, 60%, and 30% of selected isolates, respectively, and 40% of tested isolates were extended-spectrum β-lactamases (ESBLs) producers. Interestingly, all ESBLs producers harbored class 1 integrase gene (IntI1), while 60% of ESBLs producers harbored both CTX-M-1 and TEM. All tested isolates were capsulated while 87.5% were biofilm producers. Fimbriae were detected in 90% of tested isolates (all were biofilm producers and type 3 fimbriae adhesion gene [mrkD] positive). Sequence analysis of OXA-48, qnrS, and IntI1 revealed 100% identity with published sequences, while sequencing of qnrA, OmpK-35, and iron regulatory protein gene (irp2) showed minor variations in the form of one or few single-nucleotide polymorphism. Altogether, the current study revealed that all MDR, XDR, and PDR K. pneumoniae isolates were multivirulent and all harbored 3-5 virulence genes and 2-9 antimicrobial resistance genes and exhibited 8 and 10 different virulence and antimicrobial resistance profiles, respectively. In this study, we also report a positive correlation between some virulence genes and antimicrobial resistance genes among K. pneumoniae tested isolates.
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Affiliation(s)
- Ramadan A El-Domany
- Department of Microbiology and Immunology, Faculty of Pharmacy, Kafr El sheikh University, Kafr El Sheikh, Egypt
| | - Omayma A Awadalla
- Department of Microbiology, Faculty of Science, Tanta University, Tanta, Egypt
| | - Samya A Shabana
- Department of Microbiology, Faculty of Science, Tanta University, Tanta, Egypt
| | - Mona A El-Dardir
- Department of Microbiology, Faculty of Science, Tanta University, Tanta, Egypt
| | - Mohamed Emara
- Department of Microbiology and Immunology, Faculty of Pharmacy, Helwan University, Cairo, Egypt
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Frequency of qnr and aac(6’)Ib-cr Genes Among ESBL-Producing Klebsiella pneumoniae Strains Isolated from Burn Patients in Kermanshah, Iran. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.100348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Assessment of bacteria such as Klebsiella pneumonia has shown that Plasmid-mediated quinolone resistance (PMQR) affects antibiotics resistance (e.g., quinolones). Objectives: We studied the prevalence of qnr and aac(6’)Ib-cr genes in extended-spectrum beta-lactamase (ESBL)-producing K. pneumonia strains isolated from burn wounds of patients in the city of Kermanshah, Iran. Methods: This descriptive-analytical study was conducted on 126 K. pneumonia strains isolated collected from burn wounds. Biochemical tests were used to detect the strains. The frequency of the ESBL-producing isolates was determined by phenotypic tests of the combination disk (CD) method after determining the antibiotic susceptibility pattern of the isolates through the Kirby-Bauer disc diffusion test. The prevalence of the qnr and aac(6’)-Ib-cr genes was determined using their special primers as well as polymerase chain reaction (PCR). Results: Of the 126 K. pneumonia isolates, 52 (41.3%) were identified as ESBL-producing strains. ESBL-producing isolates showed higher resistance against antibiotics than non-ESBL-producing ones. PMQR relevance and resistance to ciprofloxacin were, respectively, determined at 80.76% and 59.6%. The most frequent gene was aac(6’)-Ib-cr (n = 70, 55.6%), followed by the qnrB (n = 44, 34.9%). Conclusions: This study showed a high prevalence of qnr genes in ESBL-producing K. pneumonia isolates and antibiotic resistance. Given the horizontal transmission of antibiotic resistance genes among bacteria by mobile genetic elements, timely identification of infections caused by ESBL-producing and antimicrobial-resistant K. pneumonia strains is of paramount importance.
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Taha SA, Omar HH, Hassan WH. Characterization of plasmid-mediated qnrA and qnrB genes among Enterobacteriaceae strains: quinolone resistance and ESBL production in Ismailia, Egypt. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2019. [DOI: 10.1186/s43042-019-0026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Plasmid-mediated quinolone resistance genes (PMQR) are mainly associated with clinical isolates of Enterobacteriaceae and complicate treatment of infections caused by these isolates worldwide. Extended-spectrum-beta-lactamase (ESBL)-producing bacteria are resistant to common antibiotics and also through many mechanisms, ESBL could be disabling other types of antibiotics. This study aimed to assess the prevalence of quinolone resistance and ESBL among Enterobacteriaceae strains and investigated the presence of qnrA and qnrB genes in these strains which were isolated from urinary tract infections in Ismailia, Egypt. Ninety-four Enterobacteriaceae isolates were collected from cases of UTIs admitted to the intensive care unit, Suez-Canal University Hospitals, between October 2017 and January 2018. Antibacterial susceptibility was determined by the disk diffusion method. A polymerase chain reaction assay was used to detect qnrA and qnrB resistance genes in quinolone- and fluoroquinolone-resistant and ESBL strains. Also, ciprofloxacin MIC was determined by the agar dilution method.
Results
Resistance rates were 59.6%, 54.3%, 53.2%, 53.2%, and 53.2% to NA, LEV, NOR, CIP, and FX, respectively. Of 56 NA-resistant isolates, 7 (12.5%) and 6 (10.7%) were positive for qnrA and qnrB, respectively, with only one isolate co-harboring both genes. ESBL-producing bacteria was 66.2% of isolates. The MICs for ciprofloxacin ranged from 32–256 μg/ml in ciprofloxacin-resistant isolates.
Conclusion
Our study shows high resistance rates of Enterobacteriaceae to quinolones and ESBL in our hospital which necessitate appropriate use of these antibiotics to reserve their application for therapy. The prevalence of quinolone-resistant and ESBL-producing Enterobacteriaceae was approximately 60% and 70% respectively.
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High Frequency of qnr Genes in Urinary Isolates of Extended-Spectrum β-Lactamase (ESBL)-producing Klebsiella pneumoniae in Tehran, Iran. ACTA ACUST UNITED AC 2019. [DOI: 10.5812/semj.92032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yassine I, Rafei R, Osman M, Mallat H, Dabboussi F, Hamze M. Plasmid-mediated quinolone resistance: Mechanisms, detection, and epidemiology in the Arab countries. INFECTION GENETICS AND EVOLUTION 2019; 76:104020. [PMID: 31493557 DOI: 10.1016/j.meegid.2019.104020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/24/2019] [Accepted: 08/28/2019] [Indexed: 01/19/2023]
Abstract
Quinolones are an important antimicrobial class used widely in the treatment of enterobacterial infections. Although there are multiple mechanisms of quinolone resistance, attention should be paid to plasmid-mediated genes due to their ability to facilitate the spread of quinolone resistance, the selection of mutants with a higher-level of quinolone resistance, and the promotion of treatment failure. Since their discovery in 1998, plasmid-mediated quinolone resistance (PMQR) mechanisms have been reported more frequently worldwide especially with the extensive use of quinolones in humans and animals. Nevertheless, data from the Arab countries are rare and often scattered. Understanding the prevalence and distribution of PMQR is essential to stop the irrational use of quinolone in these countries. This manuscript describes the quinolone resistance mechanisms and particularly PMQR among Enterobacteriaceae as well as their methods of detection. Then the available data on the epidemiology of PMQR in clinical and environmental isolates from the Arab countries are extensively reviewed along with the other associated resistance genes. These data shows a wide dissemination of PMQR genes among Enterobacteriaceae isolates from humans, animals, and environments in these countries with increasing rates over the years and a common association with other antibiotic resistance genes as blaCTX-M-15. The incontrovertible emergence of PMQR in the Arab countries highlights the pressing need for effective stewardship efforts to prevent the selection of a higher rate of quinolone resistance and to preserve these crucial antibiotics.
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Affiliation(s)
- Iman Yassine
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Hassan Mallat
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
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Barguigua A, Rguibi Idrissi H, Nayme K, Timinouni M. Virulence and Antibiotic Resistance Patterns in E. coli, Morocco. ECOHEALTH 2019; 16:570-575. [PMID: 30895488 DOI: 10.1007/s10393-019-01404-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/22/2018] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
Of 28 non-duplicate isolates of Escherichia coli recovered from yellow-legged Larus michahellis in Morocco, 92.86% were resistant to more than three antibiotics and 71.4% were multidrug resistant. Phylogenetic group A was most predominant (57.14%), followed by B1 (18%), B2 (14.28%) and F (10.71%). One isolate was resistant to ertapenem and contained the blaOXA-48 gene. The plasmid-mediated quinolone resistance determinants were detected in nine isolates (aac(6')-Ib-cr, qnrS1, qnrB1). Thirteen isolates carried one of the Shiga toxin E. coli-associated genes: stx1 (n = 6), stx2 (n = 5) and eae (n = 2) genes. Our data support the idea that gull feces may create potential public health risk.
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Affiliation(s)
- Abouddihaj Barguigua
- Laboratory of Biotechnology and Sustainable Development of Natural Resources, Polydisciplinary Faculty, Sultan Moulay Slimane University, Bd Ibn Khaldoun, 23000, Beni Mellal, Morocco.
| | - Hamid Rguibi Idrissi
- Laboratory of Biodiversity, Ecology and Genome, Centre of Research "Plant and Microbial Biotechnology, Biodiversity and Environment, Faculty of Sciences, University Mohammed V, Rabat, Morocco
| | - Kaoutar Nayme
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360, Casablanca, Morocco
| | - Mohammed Timinouni
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360, Casablanca, Morocco
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Salah FD, Soubeiga ST, Ouattara AK, Sadji AY, Metuor-Dabire A, Obiri-Yeboah D, Banla-Kere A, Karou S, Simpore J. Distribution of quinolone resistance gene ( qnr) in ESBL-producing Escherichia coli and Klebsiella spp. in Lomé, Togo. Antimicrob Resist Infect Control 2019; 8:104. [PMID: 31244995 PMCID: PMC6582466 DOI: 10.1186/s13756-019-0552-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/04/2019] [Indexed: 11/26/2022] Open
Abstract
Background Qnr genes are known to confer a low-level resistance to fluoroquinolone in Enterobacteriaceae. They are often found on the same resistance plasmids as extended spectrum β-lactamase (ESBL) and constitute the most common antibiotic resistance mechanism. This study aimed to detect the presence of qnr genes in ESBL-producing E. coli and Klebsiella spp. Methods From May 2013 to July 2015, 91 E. coli and 64 Klebsiella spp. strains with phenotypic resistance to quinolone were collected from several specimens and analyzed for the detection of qnrA, qnrB, qnrS genes and the β-lactamase resistance genes (blaCTX-M, blaTEM, blaSHV) using simplex and multiplex PCR. Results In the present study, 107 (69%; 61 E. coli and 46 Klebsiella spp.) of 155 bacterial strains tested were found harboring at least one qnr gene consisting of 74 (47.74%) qnrB, 73 (47.10%) qnrS and 4 (2.58%) qnrA. Of the 107 strains encoding qnr genes, 102, 96 and 52 carried CTX-M1, TEM and SHV type ESBL respectively. Conclusion This study identified quinolone resistance (qnr) gene in ESBL-producing E. coli and Klebsiella spp. in Togo. These finding which suggest a possible resistance to quinolone are of high interest for better management of patients and control of antimicrobial resistance in Togo. Electronic supplementary material The online version of this article (10.1186/s13756-019-0552-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fortune Djimabi Salah
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Ouaga I Prof Joseph Ki Zerbo, BP 364, Ouagadougou, Burkina Faso.,Bacteriology Laboratory, National Institute of Hygiene (INH), BP 1396, Lomé, Togo
| | - Serge Théophile Soubeiga
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Ouaga I Prof Joseph Ki Zerbo, BP 364, Ouagadougou, Burkina Faso
| | - Abdoul Karim Ouattara
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Ouaga I Prof Joseph Ki Zerbo, BP 364, Ouagadougou, Burkina Faso
| | - Adodo Yao Sadji
- Bacteriology Laboratory, National Institute of Hygiene (INH), BP 1396, Lomé, Togo
| | - Amana Metuor-Dabire
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Ouaga I Prof Joseph Ki Zerbo, BP 364, Ouagadougou, Burkina Faso
| | - Dorcas Obiri-Yeboah
- 4Department of Microbiology and Immunology, School of Medical Sciences, University of cape Coast, PMB, Cape Coast, Ghana
| | - Abiba Banla-Kere
- Bacteriology Laboratory, National Institute of Hygiene (INH), BP 1396, Lomé, Togo
| | - Simplice Karou
- 3High School of Biological and Food Techniques (ESTBA), University of Lomé, BP 1515, Lomé, Togo
| | - Jacques Simpore
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Ouaga I Prof Joseph Ki Zerbo, BP 364, Ouagadougou, Burkina Faso
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Mahmoudi H, Ghiasvand S, Zarei O, Hossainpour H, Alikhani MY. Identification of Quinolone and Colistin Resistance Genes in Escherichia Coli Strains Isolated from Mucosal Samples of Patients with Colorectal Cancer and Healthy Subjects. ACTA ACUST UNITED AC 2019; 15:30-40. [PMID: 31198116 PMCID: PMC8506916 DOI: 10.2174/1574891x14666190611125951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/29/2019] [Accepted: 05/15/2019] [Indexed: 01/05/2023]
Abstract
Introduction Antibiotic resistance and extensive use of antibiotics are amongst the major causes of failure in antibiotic treatment. The purpose of this study was to investigate antibiotic resistance patterns and to identify resistance genes of quinolones and colistin in Escherichia coli. There are a very few patents on E. coli isolated from colorectal cancer. So, this study demonstrates that some bacteria resistant to ciprofloxacin have not resistance genes.Moreover, new patterns for E. coli are presented for isolates of patients with colorectal cancer. Materials and Methods Of the three healthy people, inflammatory bowel diseases (IBD) patients and colorectal cancer patients, 40 E. coli strains isolated after confirmation by biochemical and molecular methods. The susceptibility of isolates to antibiotics was investigated using disk diffusion test. After deoxyribonucleic acid (DNA) extraction, polymerase chain reaction (PCR) was used to identify genes encoding resistance to ciprofloxacin (qnr A, qnr B) and colistin (mcr-1). Results The results showed that E. coli isolates from colorectal cancer patients had the highest resistance to piperacillin (67.5%), ceftazidime (47.5%), and cefepime (42.5%). Also, E. coli strains isolated from IBD patients showed resistance to antibiotic ceftazidime 13%. More than 95% of E. coli strains isolated from healthy people were susceptible to antibiotics. Based on the results, 18 (15%) E. coli strains showed resistance to ciprofloxacin. The qnr A gene was detected in 61.11% isolates; however, qnr B was detected in 9 (50%) isolates. Isolates resistant to colistin were not observed. Conclusion These findings indicate increased resistance of E. coli to ciprofloxacin in comparison with prior studies. Further research in this field will increase our knowledge and more effective exposure to the antibiotic resistance of the pathogenic microorganisms.
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Affiliation(s)
- Hassan Mahmoudi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sima Ghiasvand
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Omid Zarei
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hadi Hossainpour
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Y Alikhani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Abd ElSalam M, Gamal D, El Said M, Salem D, Abu Aitta A, S El Gamal M. Prevalence of Plasmid-Mediated Quinolone Resistance in Multidrug-Resistant Gram Negative Bacilli in Egypt. ACTA ACUST UNITED AC 2018. [DOI: 10.13005/bpj/1565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Resistance to quinolone has increased significantly and one of the most reasons is plasmid-mediated quinolone resistance (PMQR). The aim of this study is to detect the prevalence of PMQR in multidrug-resistant (MDR) Gram negative bacilli and to characterize these resistance genes. A total of 420 Gram negative bacilli clinical isolates were collected from patients attending Misr children hospital. Isolates were identified by biochemical reactions, while antimicrobial susceptibility testingwas done by Kirby-Bauer disk diffusion method. Minimum inhibitory concentrations (MIC) of ciprofloxacin were detected by E-test, whereas combined test method was used to detect extended-spectrum β-lactamase (ESBL) production. QnrA, qnrB, and qnrS genes were determined by multiplex polymerase chain reaction (PCR). MDRGram negative bacilli represented 68% (268/420); most of them were recovered from blood culture specimens (21%).Among these MDR isolates21%(60/268) were ciprofloxacin resistant; with MICs >32µg/ml in 95% of the isolates.ESBL production was detected in 11.7% of the studied isolates. The qnr genes were detected in 60%. QnrS and qnrB were the detected genes in 77.8% and 16.7% of the isolates respectively. Both qnrB and qnrS genes were determined simultaneously in 5.5%.QnrB gene was found alone in only one isolate (14.3%) that was ESBL-producer. The most MDR isolates were recovered from blood culture; this confirms the occurrence of these superbugs and their ability to cause life threatening infections. The prevalence of quinolone resistant Gram negative bacilli clinical isolates is high. The mostly prevalent PMQR gene is qnrS followed by qnrB.
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Affiliation(s)
- Mohamed Abd ElSalam
- Departmentof Botany and Microbiology, Faculty of Science (Boys), Al-Azhar University, Cairo, Egypt
| | - Doaa Gamal
- Department of Microbiology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Manal El Said
- Department of Microbiology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Dalia Salem
- Department of Microbiology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Aisha Abu Aitta
- Department of Microbiology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mamdouh S El Gamal
- Departmentof Botany and Microbiology, Faculty of Science (Boys), Al-Azhar University, Cairo, Egypt
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Benaicha H, Barrijal S, Ezzakkioui F, Elmalki F. Prevalence of PMQR genes in E. coli and Klebsiella spp. isolated from North-West of Morocco. J Glob Antimicrob Resist 2017; 10:321-325. [DOI: 10.1016/j.jgar.2017.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 05/18/2017] [Accepted: 05/29/2017] [Indexed: 11/29/2022] Open
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Cheikh A, Belefquih B, Chajai Y, Cheikhaoui Y, El Hassani A, Benouda A. Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: "retrospective cohort study". BMC Infect Dis 2017; 17:237. [PMID: 28356079 PMCID: PMC5372307 DOI: 10.1186/s12879-017-2346-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 03/25/2017] [Indexed: 11/29/2022] Open
Abstract
Background Children with cardiac defects need many hospitalizations and repetitive antibiotic therapies, with an increasing risk of colonization with multidrug-resistant bacteria (MDRB) such as extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) Post-operative infections with these bacteria in paediatric cardiac surgery are life threatening. This article aims to study the prevalence of ESBL colonization among paediatric cardiac surgery patients, and to compare occurrence of post-operative infections with and without ESBL colonization. We also aim to study the correlation between the onset of postoperative infection and other parameters such as age, length of stay and preoperative antibiotic therapy. Methods A retrospective cohort study included paediatric cardiac surgery patients in Cheikh Zaid hospital in Rabat, Morocco, between the 1st of January 2011 and 31 December 2014. A screening for ESBL colonization was requested for children who had a risk factor (previous hospitalization and/or taking antibiotics) at admission. Swabs were collected from three sites (throat, nose and anus). Two groups were compared – patients colonized and not colonized with ESBLs. Statistical analysis was performed using R software. Results ESBL colonization screening was performed in 111 patients. Positive colonization was detected in 17 cases (15%). Klebsiella pneumoniae (KP): 9 (53%) was the most frequently isolated species. Among the 17 patients, 23.5% (4/17) developed a postoperative infection due to ESBLs versus only one patient without colonization (1%). There was a statically significant difference in terms of occurrence of postoperative infection between the two groups (p = 0.001). Relative risk of developing a postoperative infection with positive colonization was 22 (95% CI, 8.37–58.5). Conclusions The analysis of colonization with multidrug-resistant bacteria and the prevention of nosocomial infections appear to be important challenges for paediatric cardiac surgery. Systematic screening of ESBL colonization for cardiac surgery could have a significant contribution, on one hand to guide prophylactic antibiotic therapy of patients, and on the other, to prevent spread of those infections.
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Affiliation(s)
- Amine Cheikh
- Department of pharmacy, Abulcasis University, Cheikh Zaid Hospital, Rabat, Morocco.
| | - Bouchra Belefquih
- Department of Microbiology, Faculty of Medicine, Mohammed VI University of Health Sciences, Microbiology Unit, National Reference Laboratory, Casablanca, Morocco
| | - Younes Chajai
- Department of Intensive care, Abulcasis University, Cheikh Zaid Hospital, Rabat, Morocco
| | - Younes Cheikhaoui
- Department of pediatric cardiac surgery, Cheikh Zaid Hospital, Rabat, Morocco
| | - Amine El Hassani
- Department of pediatrics, Mohammed V University, Cheikh Zaid Hospital, Rabat, Morocco
| | - Amina Benouda
- Department of Microbiology, Cheikh Zaid Hospital, Rabat, Morocco
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Abbasi H, Ranjbar R. The prevalence of quinolone resistance genes of A, B, S in Escherichia coli strains isolated from three major hospitals in Tehran, Iran. Cent European J Urol 2017; 71:129-133. [PMID: 29732219 PMCID: PMC5926638 DOI: 10.5173/ceju.2018.1539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/16/2017] [Accepted: 01/14/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Escherichia coli (E.coli) as an opportunistic pathogen is a major cause of the hospital infections. The main goal of this research was to determine the frequency of quinolone resistance genes (qnr) among E.coli pathotypes isolated from patients with urinary tract infections (UTIs). Material and methods Urine samples were obtained from patients with UTIs in three major hospitals of Mofid, Bu Ali, and Vali-Asr during the year of 2015 in Tehran, Iran. The antibiogram was done for isolated bacterial isolates using nalidixic acid, norfloxacin, gentamicin, streptomycin, and chloramphenicol. Then the plasmids of the bacterial samples were extracted. PCR was used to detect qnr genes. Finally, the PCR products were run on a 1% agarose gel electrophoresis and the results were analyzed by the program SPSS version 22. Results Overall, 100 E.coli strains were isolated from patients with UTIs. The highest resistance rate was against Streptomycin. The frequency of the genes of qnrA, qnrB and qnrS were 0%, 25% and 36%, respectively. Moreover, the presence of the both genes of qnrB and qnrS was recognized in 10% of isolated bacterial strains. Conclusions Our results indicated increasing rates of quinolone resistant E.coli strains circulating in hospitals under the study. Dissemination of these strains harboring qnr determinants is of particular concern.
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Affiliation(s)
- Hadis Abbasi
- MSC Microbiology Department, Islamic Azad University, North Tehran Branch, Tehran, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Arhoune B, Oumokhtar B, Hmami F, Barguigua A, Timinouni M, El Fakir S, Chami F, Bouharrou A. Rectal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae among hospitalised neonates in a neonatal intensive care unit in Fez, Morocco. J Glob Antimicrob Resist 2016; 8:90-96. [PMID: 28039104 DOI: 10.1016/j.jgar.2016.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/31/2016] [Accepted: 11/06/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the faecal carriage and molecular epidemiology of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBLE) isolated from rectal samples of neonates hospitalised in a neonatal intensive care unit (NICU) of a university hospital in Fez, Morocco. METHODS From February-July 2013, all neonates hospitalised in the NICU were screened for ESBLE carriage at discharge. ESBLs were identified by double-disk synergy test, PCR and DNA sequencing analysis. ESBLE were analysed by pulsed-field gel electrophoresis (PFGE), and conjugation was performed by the broth mating method. RESULTS In this study, 169 Enterobacteriaceae were collected from 164 neonates. The prevalence of faecal carriage of ESBLE was 58.0% (98/169), predominantly Klebsiella pneumoniae (65/98; 66.3%). A high rate of multiresistance in ESBLE was noted. blaCTX-M-1 group (78.5%) was the most frequent ESBL gene detected, and all isolates harboured the CTX-M-15 variant. The prevalence of carbapenemase-producing Enterobacteriaceae was 1.8%, and blaOXA-48 was the only gene found in these isolates. Sequencing revealed subgroups corresponding to bla(CTX-M-15,TEM-1,TEM-104,SHV-1,SHV-44,SHV-49andSHV-133) genes. Conjugation experiments showed the transferability of blaCTX-M-15 and blaTEM, but not blaSHV. These genes were carried by a high-molecular-weight conjugative plasmid (ca. 125kb). PFGE profiles demonstrated high clonal dissemination of ESBL-positive strains in the NICU. CONCLUSIONS These results demonstrate the existence of high clonal transmission of ESBLE in a Moroccan NICU. This finding provides useful information to implement a screening policy for resistant Enterobacteriaceae among neonates hospitalised in this ward.
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Affiliation(s)
- Btissam Arhoune
- Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco; Faculty of Sciences Dhar El Mahraz, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Bouchra Oumokhtar
- Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
| | - Fouzia Hmami
- Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco; Neonatal Intensive Care Unit, University Hospital Hassan II, Fez, Morocco
| | - Abouddihaj Barguigua
- Research Department, Pasteur Institute of Morocco, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | | | - Samira El Fakir
- Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Fouzia Chami
- Faculty of Sciences Dhar El Mahraz, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Abdelhak Bouharrou
- Faculty of Medicine, Sidi Mohammed Ben Abdellah University, Fez, Morocco; Neonatal Intensive Care Unit, University Hospital Hassan II, Fez, Morocco
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Plasmid-mediated quinolone resistance in Enterobacteriaceae: a systematic review with a focus on Mediterranean countries. Eur J Clin Microbiol Infect Dis 2016; 36:421-435. [PMID: 27889879 DOI: 10.1007/s10096-016-2847-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
Quinolones are a family of synthetic broad-spectrum antimicrobial drugs. These molecules have been widely prescribed to treat various infectious diseases and have been classified into several generations based on their spectrum of activity. Quinolones inhibit bacterial DNA synthesis by interfering with the action of DNA gyrase and topoisomerase IV. Mutations in the genes encoding these targets are the most common mechanisms of high-level fluoroquinolone resistance. Moreover, three mechanisms for plasmid-mediated quinolone resistance (PMQR) have been discovered since 1998 and include Qnr proteins, the aminoglycoside acetyltransferase AAC(6')-Ib-cr, and plasmid-mediated efflux pumps QepA and OqxAB. Plasmids with these mechanisms often encode additional antimicrobial resistance (extended spectrum beta-lactamases [ESBLs] and plasmidic AmpC [pAmpC] ß-lactamases) and can transfer multidrug resistance. The PMQR determinants are disseminated in Mediterranean countries with prevalence relatively high depending on the sources and the regions, highlighting the necessity of long-term surveillance for the future monitoring of trends in the occurrence of PMQR genes.
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Peymani A, Farivar TN, Najafipour R, Mansouri S. High prevalence of plasmid-mediated quinolone resistance determinants in Enterobacter cloacae isolated from hospitals of the Qazvin, Alborz, and Tehran provinces, Iran. Rev Soc Bras Med Trop 2016; 49:286-91. [DOI: 10.1590/0037-8682-0454-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/28/2016] [Indexed: 11/22/2022] Open
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Abstract
Three mechanisms for plasmid-mediated quinolone resistance (PMQR) have been discovered since 1998. Plasmid genes qnrA, qnrB, qnrC, qnrD, qnrS, and qnrVC code for proteins of the pentapeptide repeat family that protects DNA gyrase and topoisomerase IV from quinolone inhibition. The qnr genes appear to have been acquired from chromosomal genes in aquatic bacteria, are usually associated with mobilizing or transposable elements on plasmids, and are often incorporated into sul1-type integrons. The second plasmid-mediated mechanism involves acetylation of quinolones with an appropriate amino nitrogen target by a variant of the common aminoglycoside acetyltransferase AAC(6')-Ib. The third mechanism is enhanced efflux produced by plasmid genes for pumps QepAB and OqxAB. PMQR has been found in clinical and environmental isolates around the world and appears to be spreading. The plasmid-mediated mechanisms provide only low-level resistance that by itself does not exceed the clinical breakpoint for susceptibility but nonetheless facilitates selection of higher-level resistance and makes infection by pathogens containing PMQR harder to treat.
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Harifi Mood E, Meshkat Z, Izadi N, Rezaei M, Amel Jamehdar S, Naderi Nasab M. Prevalence of Quinolone Resistance Genes Among Extended-Spectrum B-Lactamase-Producing Escherichia coli in Mashhad, Iran. Jundishapur J Microbiol 2015; 8:e16217. [PMID: 26870307 PMCID: PMC4746706 DOI: 10.5812/jjm.16217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 04/13/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Escherichia coli is an important bacterial species based on incidence and associated infection severity. Some E. coli strains produce extended-spectrum beta lactamase (ESBL) and are called ESBL-producing E. coli. These strains are resistant to most classes of cephalosporin and a number of other classes of antibiotics. Plasmids carrying qnr genes have been found to transmit quinolone resistance. Objectives: The aim of this study was to determine the frequency of qnr genes in ESBL-producing and non-ESBL-producing E. coli isolated from outpatient and hospitalized patient clinical specimens from Imam Reza hospital in Mashhad, Iran. Materials and Methods: Two hundred E. coli strains, isolated from different clinical specimens were used. ESBL-producing E. coli were detected by determining susceptibility to ceftazidime, cefotaxime, and cefpodoxime with the phenotypic confirmatory test (PCT). PCR analysis was employed to detect the qnrA, qnrB, qnrS, blaTEM, and blaSHV genes. Results: Eighty-six (43%) isolates were ciprofloxacin-resistant. The PCT identified 85 (42.5%) of 200 E. coli isolates as ESBL-producing. The blaTEM, blaSHV, qnrA, qnrB, and qnrS gene were found in 65 (76.47%), 23 (27%), 63 (31%), 34 (17%), and 14 (7%) isolates, respectively. Conclusions: The high prevalence of quinolone resistance genes, which indicates antibiotic resistance, in the Imam Reza Hospital of Mashhad is a major concern. Hence, the antibiotics prescription policy should be revised, and infection control measures should be improved.
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Affiliation(s)
- Elnaz Harifi Mood
- Student Research Committee (SRC), Mashhad University of Medical Sciences, Mashhad, IR Iran
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Zahra Meshkat
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Nafiseh Izadi
- Student Research Committee (SRC), Mashhad University of Medical Sciences, Mashhad, IR Iran
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Maryam Rezaei
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Saeid Amel Jamehdar
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahboubeh Naderi Nasab
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Mahboubeh Naderi Nasab, Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9151164627, Fax: +98-5117636185, E-mail:
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Prevalence of Plasmid-Mediated Quinolone Resistance Genes among Extended-Spectrum β -Lactamase-Producing Klebsiella pneumoniae Human Isolates in Iran. J Pathog 2015; 2015:434391. [PMID: 26618005 PMCID: PMC4649097 DOI: 10.1155/2015/434391] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/06/2015] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to determine the prevalence and molecular characterization of plasmid-mediated quinolone resistance (PMQR) genes (qnrA, qnrB, qnrS, aac(6′)-Ib-cr, and qepA) among ESBL-producing Klebsiella pneumoniae isolates in Kashan, Iran. A total of 185 K. pneumoniae isolates were tested for quinolone resistance and ESBL-producing using the disk diffusion method and double disk synergy (DDST) confirmatory test. ESBL-producing strains were further evaluated for the blaCTX-M genes. The PCR method was used to show presence of plasmid-mediated quinolone resistance genes and the purified PCR products were sequenced. Eighty-seven ESBL-producing strains were identified by DDST confirmatory test and majority (70, 80.5%) of which carried blaCTX-M genes including CTX-M-1 (60%), CTX-M-2 (42.9%), and CTX-M-9 (34.3%). Seventy-seven ESBL-producing K. pneumoniae isolates harbored PMQR genes, which mostly consisted of aac(6′)-Ib-cr (70.1%) and qnrB (46.0%), followed by qnrS (5.7%). Among the 77 PMQR-positive isolates, 27 (35.1%) and 1 (1.3%) carried 2 and 3 different PMQR genes, respectively. However, qnrA and qepA were not found in any isolate. Our results highlight high ESBL occurrence with CTX-M type and high frequency of plasmid-mediated quinolone resistance genes among ESBL-producing K. pneumoniae isolates in Kashan.
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El bouamri M, Arsalane L, Zerouali K, Katfy K, El kamouni Y, Zouhair S. Molecular characterization of extended spectrum β-lactamase-producing Escherichia coli in a university hospital in Morocco, North Africa. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2015.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sedighi I, Arabestani MR, Rahimbakhsh A, Karimitabar Z, Alikhani MY. Dissemination of Extended-Spectrum β-Lactamases and Quinolone Resistance Genes Among Clinical Isolates of Uropathogenic Escherichia coli in Children. Jundishapur J Microbiol 2015; 8:e19184. [PMID: 26421128 PMCID: PMC4584072 DOI: 10.5812/jjm.19184v2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most common childhood bacterial infections and Escherichia coli is the major pathogen. Producing β-lactamase enzymes are the most common mechanism of bacterial resistance. OBJECTIVES This study aimed to determine the prevalence of Extended-Spectrum β-Lactamases (ESBLs) and Quinolone Resistance (qnr) genes in E. coli strains isolated from UTIs. MATERIALS AND METHODS In this study, a total of 120 isolates of E. coli from urinary tract infections of the children were collected at Besat Hospital in Hamadan, Iran, from October 2010 to October 2011. The bacterial isolates were identified by standard biochemical methods. Antimicrobial susceptibilities were determined by disk diffusion method, and ESBLs-producing was confirmed phenotypically using the double-disk synergy (DDS) test. The presence and identification of ESBLs and qnr genes were determined by Polymerase Chain Reaction (PCR). RESULTS The highest sensitivity was seen to imipenem (96.7%), amikacin (92.5%), nitrofurantoin (93.3%), ofloxacin (81.7%), gentamicin norfloxacin (70.8%), and ciprofloxacin (79.2%). In contrast, the highest rate of resistance was seen to co-trimoxazole (77%) and nalidixic acid (40.9%). The results showed that 6 (2.18%) and 4 (1.12%) isolates of ESBL-producing E. coli were positive with respect to having qnrB and qnrS genes, respectively. No isolates was found to have qnrA. CONCLUSIONS CTX-M was the most prevalent ESBL genotype in uropathogenic E. coli (UPEC) isolated from UTI. In addition, a high frequency of qnr genes among ESBL-producing E. coli was identified in this study. In order to avoid treatment failures, we recommend using phenotypic and molecular methods to diagnose these enzymes and qnr genes.
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Affiliation(s)
- Iraj Sedighi
- Department of Pediatric, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mohammad Reza Arabestani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Ali Rahimbakhsh
- Department of Microbiology, Faculty of Basic and Medical Sciences, Islamic Azad University of Zanjan, Zanjan, IR Iran
| | - Zahra Karimitabar
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran
- Corresponding author: Mohammad Yousef Alikhani, Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, IR Iran. Tel: +98-8118380755, Fax: +98-8118380130, E-mail:
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Betitra Y, Teresa V, Miguel V, Abdelaziz T. Determinants of quinolone resistance in Escherichia coli causing community-acquired urinary tract infection in Bejaia, Algeria. ASIAN PAC J TROP MED 2015; 7:462-7. [PMID: 25066395 DOI: 10.1016/s1995-7645(14)60075-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/15/2014] [Accepted: 02/15/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To investigate the mechanisms of quinolone resistance and the association with other resistance markers among Esherichia coli (E. coli) strains isolated from outpatient with urinary tract infection in north of Algeria. METHODS A total of 30 nalidixic acid-resistant E. coli isolates from outpatient with urinary tract infections from January 2010 to April 2011 in north of Algeria (Bejaia) were studied. Antimicrobial susceptibility was determined by disc diffusion assay, minimal inhibitory concentrations (MIC) of quinolone were determined by microdilution. Mutations in the Quinolone Resistance-Determining Region (QRDR) of gyrA and parC genes and screening for qnr (A, B and S) and bla genes were done by PCR and DNA sequencing. RESULTS Most of the E. coli isolates (56.66%) were shown to carry mutations in gyrA and parC (gyrA: Ser83Leu + Asp87Asn and parC:Ser80Ile). While, 16.66% had only an alteration in gyrA: Ser83Leu. One isolate produced qnrB-like and two qnrS-like. Four isolates were CTX-M-15 producers associated with TEM-1 producing in one case. Co-expression of blaCTX-M-15 and qnrB was determined in one E. coli isolate. CONCLUSIONS Our findings suggested the community emergence of gyrA and parC alterations and Qnr determinants that contributed to the development and spread of fluoroquinolone resistance in Algerian E. coli isolates.
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Affiliation(s)
- Yanat Betitra
- Laboratoire d'écologie Microbiologie. Université A/Mira de Bejaia, Algérie; Laboratory of Molecular Microbiology and Antibiotics, Dept. Pathology and Experimental therapeutics. Medical School, University of Barcelona, Spain
| | - Vinuesa Teresa
- Laboratory of Molecular Microbiology and Antibiotics, Dept. Pathology and Experimental therapeutics. Medical School, University of Barcelona, Spain
| | - Viñas Miguel
- Laboratory of Molecular Microbiology and Antibiotics, Dept. Pathology and Experimental therapeutics. Medical School, University of Barcelona, Spain
| | - Touati Abdelaziz
- Laboratoire d'écologie Microbiologie. Université A/Mira de Bejaia, Algérie.
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Ferjani S, Saidani M, Amine FS, Boutiba-Ben Boubaker I. Prevalence and characterization of plasmid-mediated quinolone resistance genes in extended-spectrum β-lactamase-producing Enterobacteriaceae in a Tunisian hospital. Microb Drug Resist 2014; 21:158-66. [PMID: 25247633 DOI: 10.1089/mdr.2014.0053] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of the study was to assess the prevalence of plasmid-mediated quinolone resistance (PMQR) genes (qnrA, qnrB, qnrC, qnrD, qnrS, aac(6')-Ib-cr, qepA, and oqxAB) in a collection of 120 extended-spectrum β-lactamases (ESBLs)-producing enterobacteria and to characterize them. Overall, PMQR determinants were detected in 72 (60%) isolates (20 Escherichia coli, 32 Klebsiella pneumoniae, and 20 Enterobacter cloacae). PMQR frequencies were as follows: qnr genes (25.8%), oqxAB (21.6%), and aac(6')-Ib-cr variant (19.2%). Four qnr alleles were identified as qnrB1 (83.8%), qnrB4 (6.4%), qnrB2 (3.2%), and qnrS1 (6.4%). qnr genes were mainly detected in E. cloacae (50%), aac(6')-Ib-cr in E. coli (47.5%), and oqxAB in K. pneumoniae (65%). Overall, blaCTX-M-15 (90.3%) was the most prevalent blaESBL type followed by blaSHV-12 (6.4%) and blaSHV-27 (2.7%). Rates of mutations in gyrA and parC genes were 75% for E. coli, 72.8% for K. pneumoniae, and 50% for E. cloacae. Isolates with mutations in their quinolone resistance-determining regions exhibited high fluoroquinolones resistance levels compared to those with wild ones. Genetic study of PMQR-harboring isolates revealed a great genomic diversity among each Enterobacteriaceae species. Our findings indicate the high prevalence of PMQR determinants among ESBL-producing Enterobacteriaceae isolates from our hospital and their diffusion in various unrelated CTX-M-15-producing clones.
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Affiliation(s)
- Sana Ferjani
- 1 LR99ES09 Laboratoire de Résistance aux antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar , Tunis, Tunisie
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Tatavarthy A, Luna VA, Amuso PT. How multidrug resistance in typhoid fever affects treatment options. Ann N Y Acad Sci 2014; 1323:76-90. [PMID: 25069595 DOI: 10.1111/nyas.12490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Salmonella enterica serotype Typhi (S. Typhi) is an enteric pathogen that causes typhoid fever. The infection can be severe, with significant morbidity and mortality, requiring antimicrobial therapy. Cases of S. Typhi infection in the United States and other developed countries are often associated with travel to endemic regions. The empirical use of first-line drugs for therapy, including ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, has resulted in transmissible multidrug resistance. With the global increase in multidrug-resistant S. Typhi, use of ciprofloxacin, with excellent oral absorption, few side effects, and cost-effectiveness, has become popular for treatment. However, decreased ciprofloxacin susceptibility due to point mutations in the S. Typhi genes gyrA and/or parC has caused treatment failures, necessitating alternative therapeutic options. S. Typhi is typically genetically homogenous, with phylogenetic and epidemiological studies showing that identical clones and diverse S. Typhi types often coexist in the same geographic region. Studies investigating point mutations have demonstrated that selective pressure from empirical use of first-line drugs and fluoroquinolones has led to the global emergence of haplotype H-58. Antibiotic resistance is subject to high selective pressure in S. Typhi and thus demands careful use of antimicrobials.
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Affiliation(s)
- Aparna Tatavarthy
- Center for Biological Defense, College of Public Health, University of South Florida, Tampa, Florida
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Seyedpour SM, Eftekhar F. Quinolone Susceptibility and Detection of qnr and aac(6')-Ib-cr Genes in Community Isolates of Klebsiella pneumoniae. Jundishapur J Microbiol 2014; 7:e11136. [PMID: 25368793 PMCID: PMC4216573 DOI: 10.5812/jjm.11136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/01/2013] [Accepted: 08/01/2013] [Indexed: 01/16/2023] Open
Abstract
Background: Plasmid-mediated quinolone resistance genes (PMQR) have been shown to play not only an important role in quinolone resistance, but also resistance to other antibiotics, particularly β-lactams and aminoglycosides. These genes are mainly associated with clinical isolates of Enterobacteriaceae. However, detection of PMQR genes in the community isolates can increase the dissemination rate of resistance determinants among bacteria. Objectives: This study aimed to investigate quinolone resistance and distribution of qnr and aac (6’)-Ib-cr genes among the community isolates of Klebsiella pneumoniae. Materials and Methods: Fifty-two K. pneumoniae isolates were collected from the Central Laboratory in Karaj between July 2010 and January 2011. Antibacterial susceptibility was determined by the disc diffusion method. Quinolone and/or cephalosporin-resistant isolates were screened for the presence of qnrA, qnrB, qnrS and aac (6’)-Ib-cr genes by polymerase chain reaction (PCR). Results: Of the 52 K. pneumoniae isolates, 23 were resistant to cephalosporins and/or quinolones. Overall, 7 out of the 23 resistant isolates harbored qnr and/or aac (6’)-Ib-cr genes (30.4%). Among these, 5 isolates were resistant to both classes of antibiotics of which; 3 carried the aac (6’)-Ib-cr gene, one had the qnrS, and one harbored both aac (6’)-Ib-cr and qnrB genes. None of the isolates contained qnrA. Two isolates were sensitive to quinolones and resistant to cephalosporins of which; one had qnrS and the other carried the aac (6’)-Ib-cr gene. Conclusions: Our study showed that 30.4% of the quinolone and/or cephalosporin resistant community isolates of K. pneumoniae carried PMQR genes. These results confirm that community isolates can be an important source for spreading antibiotic resistance determinants among Gram negative pathogens. This is the first report from Iran on detection of PMQR in the community isolates of K. pneumoniae.
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Affiliation(s)
- Seyed Mohsen Seyedpour
- Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, G.C., Tehran, IR Iran
| | - Fereshteh Eftekhar
- Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, G.C., Tehran, IR Iran
- Corresponding author: Fereshteh Eftekhar, Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, G.C., Tehran, IR Iran. Tel: +98-2129903208, Fax: +98-2122431664, E-mail:
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Agabou A, Pantel A, Ouchenane Z, Lezzar N, Khemissi S, Satta D, Sotto A, Lavigne JP. First description of OXA-48-producing Escherichia coli and the pandemic clone ST131 from patients hospitalised at a military hospital in Algeria. Eur J Clin Microbiol Infect Dis 2014; 33:1641-6. [DOI: 10.1007/s10096-014-2122-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/09/2014] [Indexed: 01/18/2023]
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Storberg V. ESBL-producing Enterobacteriaceae in Africa - a non-systematic literature review of research published 2008-2012. Infect Ecol Epidemiol 2014; 4:20342. [PMID: 24765249 PMCID: PMC3955770 DOI: 10.3402/iee.v4.20342] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/21/2014] [Accepted: 02/12/2014] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL) has been found all over the world, and risk factors for acquiring these bacteria involve hospital care and antibiotic treatment. Surveillance studies are present in Europe, North America, and Asia, but there is no summarizing research published on the situation in Africa. AIM This review aims to describe the prevalence of ESBL-producing Enterobacteriaceae in hospital and community settings in Africa and the ESBL genes involved. METHOD A non-systematic literature search was performed in PubMed. All articles published between 2008 and 2012 were screened and read in full text. Relevant articles were assessed for quality of evidence and included in the review. Articles were divided into regional areas in Africa and tabulated. RESULTS ESBL-producing Enterobacteriaceae in hospitalized patients and in communities varies largely between countries and specimens but is common in Africa. ESBLs (class A and D) and plasmid-encoded AmpC (pAmpC) were regularly found, but carbapenemases were also present. CONCLUSION ESBL-producing Enterobacteriaceae in hospital and community settings in Africa is common. Surveillance of antimicrobial resistance needs to be implemented in Africa to tailor interventions targeted at stopping the dissemination of ESBL-producing Enterobacteriaceae.
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Affiliation(s)
- Viktor Storberg
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Jlili NEH, Réjiba S, Smaoui H, Guillard T, Chau F, Kechrid A, Cambau E. Trend of plasmid-mediated quinolone resistance genes at the Children's Hospital in Tunisia. J Med Microbiol 2013; 63:195-202. [PMID: 24194556 DOI: 10.1099/jmm.0.062216-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The prevalence of plasmid-mediated quinolone resistance genes [qnr, aac(6')-Ib-cr and qepA] was sought among Enterobacteriaceae strains obtained from the Children's Hospital of Tunis (Tunisia). Non-duplicate isolates (n = 278) with resistance to extended-spectrum cephalosporins and collected in 2003, 2007, 2008 and 2009 were screened for qnr genes. Forty (14.4 %) isolates were qnr positive and were screened for the presence of the aac(6')-Ib-cr and qepA genes. qnrB was detected in 21 Klebsiella pneumoniae, 11 Escherichia coli and 6 Enterobacter cloacae isolates. Sequence analysis of the qnrB amplicons revealed variants including 24 qnrB1, 11 qnrB2 and 3 qnrB6. qnrS (qnrS1 allele) was detected only in K. pneumoniae isolates, either alone (two isolates) or with the qnrB gene (one isolate). The qnrA, qnrC and qnrD genes were not found in any of the 278 isolates. No qnr-positive isolates carried the qepA gene. Pyrosequencing results showed that aac(6')-Ib-cr, a variant of the aac(6')-Ib gene, was present in 31 qnr-positive isolates (21 K. pneumoniae isolates, seven Escherichia coli isolates and three Enterobacter cloacae isolates). aac(6')-Ib was also found either alone (two isolates) or in association with aac(6')-Ib-cr (one isolate). Of the 40 qnr-positive isolates, 92.5, 82.5, 57.5, 85 and 82.5 % were non-susceptible to nalidixic acid, ciprofloxacin, levofloxacin, ofloxacin and norfloxacin, respectively, and all were extended-spectrum β-lactamase producers. Random amplified polymorphic DNA-PCR typing of these isolates showed 16, 8 and 5 different genotypes in K. pneumoniae, Escherichia coli and Enterobacter cloacae isolates, respectively. Our study highlights the high prevalence of qnr in association with aac(6')-Ib-cr among Enterobacteriaceae isolates, even from children, who are patients not overtreated with quinolones.
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Affiliation(s)
- Nour El-Houda Jlili
- EA3964, Université Paris Diderot, Paris, France.,Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Samia Réjiba
- Département des Sciences Biologiques, Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.,Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Hanen Smaoui
- Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Thomas Guillard
- Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims, F-51092 Reims, France.,EA3964, Université Paris Diderot, Paris, France
| | | | - Amel Kechrid
- Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Emmanuelle Cambau
- Laboratoire de Bactériologie, APHP, Hôpital Lariboisière, Paris, France.,EA3964, Université Paris Diderot, Paris, France
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Girlich D, Bouihat N, Poirel L, Benouda A, Nordmann P. High rate of faecal carriage of extended-spectrum β-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco. Clin Microbiol Infect 2013; 20:350-4. [PMID: 23927757 DOI: 10.1111/1469-0691.12325] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/05/2013] [Accepted: 06/30/2013] [Indexed: 11/29/2022]
Abstract
Carbapenemase-producing Enterobacteriaceae isolates are being increasingly reported, particularly from countries surrounding the Mediterranean area. We aimed to quantify the prevalence of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in rectal swabs from hospitalized patients in a University hospital in Morocco, and to compare the performance of three screening media: ChromID ESBL (bioMérieux), Brilliance CRE (OXOID, Thermofisher) and SUPERCARBA (home made). Genetic detection and plasmid analysis were performed by PCR and sequencing. Strain comparison was performed by multi-locus sequence typing and the Diversilab technique (bioMérieux). The prevalence of multidrug-resistant Enterobacteriaceae was high, with 33 ESBL producers (42.85%, mainly CTX-M-15) and 10 OXA-48 producers (13%), corresponding to two major clones of K. pneumoniae (70%) and a clone of Enterobacter cloacae (30%). The three screening media showed the same sensitivity for detection of carbapenemase-producing Enterobacteriaceae, whereas the SUPERCARBA medium was more specific than the two other media. The average faecal carriage of ESBL or carbapenemase-producing Enterobacteriaceae varied from 1 × 10(2) to >1 × 10(8) CFU/g of stools. This study shows a high prevalence of multidrug-resistant Enterobacteriaceae, and particularly of OXA-48 producers. The new carbapenem-containing medium, SUPERCARBA, was as sensitive as Brilliance CRE and ChromID ESBL, and more specific for the detection of Enterobacteriaceae expressing those carbapenemases.
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Affiliation(s)
- D Girlich
- INSERM U914 Emerging Resistance to Antibiotics, Hôpital de Bicêtre, Faculté de Médecine et Université Paris Sud, Paris, France
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Barguigua A, El Otmani F, Talmi M, Zerouali K, Timinouni M. Prevalence and types of extended spectrum β-lactamases among urinary Escherichia coli isolates in Moroccan community. Microb Pathog 2013; 61-62:16-22. [DOI: 10.1016/j.micpath.2013.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/10/2013] [Accepted: 04/23/2013] [Indexed: 11/25/2022]
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Sallem RB, Gharsa H, Slama KB, Rojo-Bezares B, Estepa V, Porres-Osante N, Jouini A, Klibi N, Sáenz Y, Boudabous A, Torres C. First detection of CTX-M-1, CMY-2, and QnrB19 resistance mechanisms in fecal Escherichia coli isolates from healthy pets in Tunisia. Vector Borne Zoonotic Dis 2013; 13:98-102. [PMID: 23289399 DOI: 10.1089/vbz.2012.1047] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Our objective was to analyze the carriage rate of extended-spectrum β-lactamase (ESBL)- and plasmidic AmpC β-lactamase (pAmpC)-producing Escherichia coli isolates in fecal samples of healthy pets (dogs and cats) and to characterize the recovered isolates for the presence of other resistance genes and integrons. Eighty fecal samples of healthy pets were inoculated in MacConkey agar plates supplemented with cefotaxime (2 μg/mL) for cefotaxime-resistant (CTX(R)) E. coli recovery. CTX(R) E. coli isolates were detected in 14 of the 80 fecal samples (17.5%) and the following β-lactamase genes (number of isolates) were detected: bla(CTX-M-1) (8), bla(CTX-M-1)+bla(TEM-1b) (3)(,) bla(CTX-M-1)+bla(TEM-1c) (1), bla(CTX-M-1)+bla(TEM-135) (1), and bla(CMY-2)+bla(TEM-1b) (1). The 14 E. coli were distributed into the phylogroups B1 (6 isolates), A (5), and D (3). The qnrB19 gene was detected in one CTX-M-1-producing strain of phylogroup D. Five isolates contained class 1 integrons with the following arrangements: dfrA17-aadA5 (2 isolates), dfrA1-aadA1 (1), and dfrA17-aadA5/ dfrA1-aadA1 (2 isolates). The virulence genes fimA and/or aer were detected in all CTX(R) strains. In this study, the pet population harbored β-lactamase and quinolone resistance genes of special interest in human health that potentially could be transmitted to humans in close contact with them.
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Affiliation(s)
- Rym Ben Sallem
- Laboratoire Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université Tunis-El Manar, Tunis, Tunisia
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Prevalence and genotypic analysis of plasmid-mediated β-lactamases among urinary Klebsiella pneumoniae isolates in Moroccan community. J Antibiot (Tokyo) 2012; 66:11-6. [PMID: 23093031 DOI: 10.1038/ja.2012.91] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study is to assess the prevalence and molecular characterization of the extended spectrum β-lactamases (ESBL)-producing Klebsiella pneumoniae isolated from community acquired urinary tract infections and collected in five Moroccan cities during a 2010 survey. In all, 34 (7.5%) of the 453 K. pneumoniae isolates studied were positive for an ESBL phenotype and 91.1% of these isolates were multidrug resistant. The bla(CTX-M-15) (n=31) was the most frequent ESBL genes detected, followed equally by bla(SHV-28) and bla(SHV-12) (n=3), then bla(TEM-3), bla(SHV-36), bla(SHV-110) and bla(CTX-M-1) with one isolate for each (n=1). Eight isolates co-expressed more than one ESBL with bla(CTX-M-15). The non-ESBL genes detected were bla(SHV-1), bla(SHV-11), bla(SHV-32), bla(SHV-26), bla(SHV-76), bla(TEM-1), bla(TEM-1b) and bla(OXA-1). Plasmid-mediated AmpC β-lactamase genes, bla(ACT-2), bla(DHA-1) and a new β-lacatamase named bla(EBC-1464), were detected in 11.7% of isolates. Fourteen (41.1%) isolates harbored qnr genes; qnrA6 (n=1), qnrB1 (n=8), qnrB2 (n=1) and qnrS1 (n=4) types were detected. Twenty-six isolates (76.4%) were positive for aac(6')-Ib-cr gene. Results of conjugation experiments indicated that bla(CTX-M-15), bla(TEM-1b), bla(OXA-1), aac(6')-Ib-cr and qnrB1 genes were co-transferred and that these genes were carried by a conjugative plasmid of high molecular weight. With the exception of qnrB1, all the antibiotic resistance genes were clustered in a 12-kb region. The results of this work report the genetic diversity of ESBL genes, with the CTX-M-15 enzyme being most common among ESBL-producing K. pneumoniae in Moroccan community. Furthermore, a major finding is that bla(EBC-1464) detection is a first in Morocco.
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